表观弥散系数在PI-RADS 3分且PSA灰区患者中的应用价值  

Application value of apparent diffusion coefficient in patients with PI-RADS score of 3 and PSA gray area

作　　者：董奇飞 陈宇涵 王常明 汪蕾 肖峻[1] DONG Qifei;CHEN Yuhan;WANG Changming;WANG Lei;XIAO Jun(Department of Urology,Affiliated Provincial Hospital of Anhui Medical University,Hefei,230001,China;Department of Urology,First Affiliated Hospital of University of Science and Technology of China,Anhui Provincial Hospital)

机构地区：[1]安徽医科大学附属安徽省立医院泌尿外科,合肥230001 [2]中国科学技术大学附属第一医院(安徽省立医院)泌尿外科

出　　处：《临床泌尿外科杂志》2024年第10期909-913,917,共6页Journal of Clinical Urology

基　　金：安徽省教育厅高校科研计划项目(No:2022AH040185);安徽省临床重点专科建设项目(2023)。

摘　　要：目的:探索表观弥散系数(apparent diffusion coefficient,ADC)在前列腺影像报告和数据系统(prostate imaging-reporting and data system,PI-RADS)3分且前列腺特异性抗原(prostate specific antigen,PSA)灰区患者中对减少非必要前列腺穿刺活检的应用价值。方法:回顾性收集2019年1月—2023年12月在中国科学技术大学附属第一医院(安徽省立医院)泌尿外科接受经会阴前列腺穿刺活检患者的临床资料。对于PI-RADS 3分病灶ADC值的计算,由1位泌尿外科医生只选择病灶上最可疑的区域,即在ADC图像上最可疑区域依次绘制2个圆形感兴趣区(region of interest,ROI)(大小为10~20 mm~(-2)),影像系统将自动计算ADC值,最终的ADC值取2次绘制的ROI所对应ADC值的平均值,记为ADC_(min)。采用Mann-Whitney U检验比较各临床变量在良、恶性组的组间差异,使用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)、灵敏度和特异度来评价各临床变量的诊断价值。结果:本研究共纳入121例患者,其中88例患者术后病理为良性、33例患者为前列腺癌(prostate cancer,PCa)(包括16例临床有意义前列腺癌患者)。前列腺体积(prostate volume,PV)、前列腺特异性抗原密度(prostate specific antigen density,PSAD)和ADC_(min)在组间比较时差异均有统计学意义。在诊断效能方面,ADC_(min)(AUC=0.810,95%CI:0.729~0.876)明显优于前列腺特异性抗原(PSA)(AUC=0.593,95%CI:0.446~0.630)、PV(AUC=0.691,95%CI:0.600~0.772)、PSAD(AUC=0.683,95%CI:0.592~0.765)。当ADC_(min)<600μm^(2)/s时,93.33%(14/15)的患者术后病理为PCa;当ADC_(min)>750μm^(2)/s时,仅有13.33%(10/75)的患者术后病理为PCa。结论:对于PI-RADS 3分且PSA灰区患者而言,ADC_(min)在区分前列腺穿刺活检术后病理良恶性中有很好的应用价值,ADC_(min)越小,患者患PCa的风险就越大。Objective To explore the value of ADCmin in reducing unnecessary prostate biopsies in patients with PI-RADS score of 3 and PSA gray area.Methods The clinical data of patients who underwent transperineal prostate biopsy in the Department of Urology of First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)from January 2019 to December 2023 were collected retrospectively.For the calculation of the ADC value of PI-RADS 3 lesions,one urologist only selects the most suspicious area on the lesion,that is,two circular regions of interest(ROI)(size of 10-20 mm-2)are drawn in turn on the most suspicious area on the ADC map,and the imaging system will automatically calculate the ADC value,and the final ADC value is taken as the average value of the ADC value corresponding to the ROI drawn twice,which is recorded as ADCmin.Mann-Whitney U test was used to compare the differences between benign and malignant groups.ROC curve,AUC,sensitivity and specificity were used to evaluate the diagnostic value of clinical variables.Results A total of 121 patients were included in this study,including 88 patients with benign pathology,33 patients with prostate cancer and 16 patients with clinically significant prostate cancer.There were significant differences in PV,PSAD and ADCmin between groups.In terms of diagnostic efficacy,ADC_(min)(AUC=0.810,95%CI:0.729-0.876)was significantly better than PSA(AUC=0.593,95%CI:0.446-0.630),PV(AUC=0.691,95%CI:0.600-0.772)and PSAD(AUC=0.683,95%CI:0.592-0.765).When ADCmin was<600μm^(2)/s,14/15(93.33%)patients were diagnosed with prostate cancer.When ADC_(min) was>750μm^(2)/s,only 10/75(13.33%)patients were diagnosed with prostate cancer.Conclusion ADCmin has good application value in distinguishing benign and malignant pathology after prostate biopsy for patients with PI-RADS score of 3 and PSA gray area.The smaller the ADCmin,the greater the risk of prostate cancer.

关 键 词：前列腺癌 前列腺穿刺 PI-RADS 3分 表观弥散系数 PSA灰区 

分 类 号：R737.25[医药卫生—肿瘤]